In the past few decades, substantial advances have been made in understanding the pathophysiology and hemodynamics of acute or decompensated heart failure (HF), leading to improved care and newer pharmacological and interventional therapies. Nevertheless, short- and long-term HF-related re-hospitalizations and mortality remain high and consume substantial amounts of healthcare resources. In recent years, multidisciplinary disease management programs (MDPs) have been developed in Europe and the United States to reduce the frequency, severity, and cost of these clinical events, and also improve the functional status and health-related life quality of HF patients.
　　In Taiwan, medical resources and the healthcare environment for HF patients differ from that of Western countries. The population density of Taiwan is 637.29 persons per km2, the tenth highest in the world. Moreover, 97% of its 22.9 million residents are covered by the country’s National Healthcare Insurance Program. Under this program, individuals can visit medical specialists directly, without referral by family doctors. Therefore, unlike in the United States and Europe, the physicians in charge of primary care of patients with HF are usually cardiologists instead of general physicians. Nevertheless, our previous study demonstrated that MDP is still effective in Taiwan for patients with acute or decompensated chronic HF covered by Taiwan’s National Healthcare Insurance Program.
　　Because of the improvement in the intervention for patients with coronary artery disease, and acute myocardial infarction, the survival rate increased remarkably. However, the survivors become the main population who will develop HF. To early plan the strategy in the care of these growing populations, we need to get into the insight of the care system of HF.
　　MDP is a program for HF patients after acute in-hospital care. The team includes cardiologists, HF disease managers, HF-specialized dieticians, physical therapists, and pharmacist. The subacute care for HF contains strategies different from the acute care, including individualized etiology-realized education, self-care and care-giver training, diet and life-style modification, home program, interaction with care center, and cardiac rehabilitation.
　　In this talk, we will discuss with you re the global burden in the world and in Taiwan, the care system and concept for HF, and also we will analyze the cost in HF, and the values of HF care programs.